Gov. Jerry Brown convened a special session of the Legislature to fix a $1 billion shortfall in health care funding — and the bill the Legislature sent to his desk would legalize physician-assisted suicide.

Supporters of measure made this argument last week: The Legislature needed to pass the End of Life Option Act because if it did not become law, then advocates would place a similar measure on the ballot. Voters were sure to pass the measure, but if it created unforeseen problems, the Legislature might face hurdles trying to correct errors embedded in an inflexible ballot measure. “We should be making those decisions,” Assemblyman Luis Alejo, D-Salinas, argued on the Assembly floor.

You would never guess that state Sens. Lois Wolk, D-Davis, and Bill Monning, D-Carmel, couldn’t get the votes earlier to pass their own “death with dignity” bill out of the Assembly Health Committee because of opposition from fellow Democrats. So in a special-session gut-and-amend-style maneuver, supporters put the Wolk-Monning language into a special-session bill. Then the leadership put different lawmakers in the special-session health committee. In short, the leadership steamrolled opposition to pass a bill that could not have survived the usual legislative process Alejo holds so dear.

Assemblyman James Gallagher, R-Nicolaus (Sutter County), tried to block the new measure on the grounds that it is not germane to the health care funding special session. The Assembly out voted him 41-28, so he must be wrong.

Most Republicans voted against the End of Life Option Act. I’ve heard from readers who believe this is hypocritical — as Republicans usually oppose government intrusion on personal decisions. They don’t realize that physician-assisted suicide laws put the state in the business of regulating suicide — a sad choice made by some 40,000 Americans annually as it is.

Democrats who spoke in opposition of the measure fear their constituents will receive less medical care if Brown signs it. Assemblywoman Cheryl Brown, D-San Bernardino, spoke of husband Hardy’s battle with ALS. Doctors predicted he would be dead a decade ago. “Had he done what this bill wants him to do, he’d not be here” today, she said, to see and enjoy his grandchildren and great-grandchildren.

“As soon as this is introduced, it immediately become the cheapest and most expedient way to deal with complicated end-of-life situations,” Aaron Kheriaty, director of the UC Irvine School of Medicine medical ethics program, told the New York Times. “You’re seeing the push for assisted suicide from generally white, upper-middle-class people, who are least likely to be pressured. You’re not seeing support from the under-insured and economically marginalized. Those people want access to better health care.”

Assemblywoman Lorena Gonzalez, D-San Diego, said that a few years ago, she would have answered yes if a pollster asked if she supported legislation modeled after Oregon’s Death With Dignity Act. After all, she believes in “choices.” But as she thought about it, “There’s no hospital in my district. Care is through community clinics.” She resents the spin this summer that suggested that if you were a Southern California Latina and opposed the bill, it was because you’re Catholic. The real issue at play here is, “There aren’t a lot of communities like mine in Oregon.” Her big fear is not that her voters will get too much health care, it’s that they will get too little.

"As mentioned in both floor debates assisted suicide proponents circumvented the normal legislative process in passing this bill during a special session on health finance."

"That said regarding this policy, we all know that 'choice' is a myth in the context of our unjust health care reality. End-of-life treatment options are already limited for millions of people—constrained by poverty, disability discrimination, and other obstacles. Adding this so-called "choice" into our dysfunctional healthcare system will push people into cheaper lethal options. There is no assurance everyone will be able to choose treatment over suicide; no material assistance for families of limited means who are struggling to care for loved ones; no meaningful protection fromabusive family members or caregivers."

"If assisted suicide is made legal, it quickly becomes just another form of treatment and as such, will always be the cheapest option. This bill offers no requirement for mental health evaluation, doesn't protect anyone from the subtle cost of treatment pressures or feelings of being a burden. In collaboration with groups representing people living with disabilities, cancer doctors, people advocating for the poor and uninsured and faith based organizations we will do everything we can to carry that message and ask the Governor Brown to veto this bill."

Sacramento, CA - Californians Against Assisted Suicide spokesperson Tim Rosales, responded to the AB2x15 (Eggman) passage in the State Assembly with the following coalition statement:

"We appreciated many eloquent statements of assisted suicide opposition from progressive legislators representing low income districts. The bipartisan opposition and narrow Assembly vote indicates that there are still so many unanswered and troubling issues with this bill as it's rushed through this special session.

"This bill remains opposed by groups representing people living with disabilities, cancer doctors, people advocating for the poor and uninsured and faith based organizations."

Many advocates of a California law allowing doctor-assisted suicide for terminally ill individuals claim that Oregon's law offers a suitable model. But there are serious problems with the legislation in Oregon and many documented cases of abuse.

I have evaluated and treated thousands of patients who wanted to end their life. A request to die is nearly always a cry for help. Among terminally ill individuals, this request is associated with depression in 59% of cases. And yet, alarmingly, in Oregon less than 5% of individuals who have died by assisted suicide were ever referred for psychiatric consultation to rule out the most common causes of suicidal thinking. Consider the case of Oregonian Michael Freeland, a man with a 43-year history of intermittent depression and suicide attempts prior to his diagnosed medical illness. The doctor who prescribed him the deadly drug did not deem it necessary to refer him for psychiatric consultation. The proposed law in California likewise does not require psychiatric screening.

We’ve seen in Oregon the problem of doctor-shopping, and cases of individuals being pressured by family members. Consider the case of 85-year-old Kate Cheney: her physician and a consulting psychiatrist declined to prescribe the life-ending medication, judging that she lacked capacity due to her dementia, and documenting that the patient’s daughter appeared “somewhat coercive”. Nevertheless, a managed care insurance company found her another doctor who did prescribe the lethal drug. The Oregon Health Division has publicly stated that it has no resources and no authority to monitor or investigate such reported cases of abuse.

Since very few practicing physicians are willing to participate in writing these prescriptions, where it is legalized doctor assisted death becomes a marginalized cottage industry: in Oregon a small number of physicians write a disproportionately large number of the prescriptions. Consider the case of the first woman to die by assisted suicide in Oregon: her physician and a second consulting doctor both refused to end her life because they judged that her request was motivated by untreated clinical depression. The assisted suicide advocacy group Compassion and Choices got involved and referred the woman to their preferred doctor who provided the deadly drug.

Despite the inadequate system of monitoring and reporting in Oregon, the data we do have paints a distressing picture. After suicide rates had declined in the 1990s, they rose dramatically in Oregon between 2000 and 2010, in the years following the legalization of assisted suicide in 1997. By 2010 suicide rates were 35% higher in Oregon than the national average. A rigorous study by David Albert Jones of Oxford University to be published next month controls for other factors that could account for this rise: this research demonstrates that the permissive assisted suicide laws have led to at least a 6% rise in overall suicide rates in Washington & Oregon.

Suicide is among the health-related behaviors that tend to spread from person-to-person through social networks—up to three degrees of separation. We know also that publicized cases lead to clusters of copycat cases. A Swiss study in 2003, for example, indicated evidence for suicide contagion following media reports of doctor-assisted suicide. Furthermore, the law itself is a teacher. These laws communicate the message that under especially difficult circumstances, some lives are not worth living. This message will be heard not only by those with a terminal illness, but by any person struggling with the temptation to end his or her own life.

The Oregon law permitting physician-assisted suicide does not offer a good model for California to follow.

Aaron Kheriaty, M.D., is associate professor of psychiatry and director of the Medical Ethics Program at UC Irvine School of Medicine.